PhD Proposal

Best practice for computerised personal health records to support medicines optimisation: Improving shared understanding for patients and practitioners.

The aim of this project is to determine how best to use computerised personal health records to help patients get the full benefit of their prescribed medication and to help practitioners give safe care. The project will apply the principles of human-computer interaction and use practitioner- and patient-defined information standards within a realist evaluation framework to understand what works, for whom and in what circumstances.

The annual NHS expenditure on medication is over £15 billion, yet within ten days of a new prescription a third of patients do not take it as directed [1]. Many patients experience avoidable drug errors due to incomplete information sharing between care providers. Current health policy articulates patient empowerment as an essential driver for change, and highlights computerised personal health records as a means to support that. However, the evidence base for personal health record benefits remains weak and inconclusive with conflicting results [2]. Further work is needed to understand how personal health records can be an effective intervention to improve outcomes [3, 4].

The Royal Pharmaceutical Society has led work with NHS England, the Royal College of GPs, the Royal College of Nursing and the Association of the British Pharmaceutical Industry to develop a framework for medicines optimisation. The first guiding principle of the framework is aiming to understand the patient’s experience. The principle aims to have a positive influence on patient engagement and their adherence to prescribed treatment. This accords with the current IT strategy for the NHS in England, which has the theme of ‘personalised care’ and pins its hopes on patient self-management reducing demand for NHS services. Unfortunately the strategy is weak on proposals for evaluation, so independent studies are necessary to ensure that published results are not merely political propaganda [5].

This project will use the realist evaluation framework as its overarching theoretical approach to identify the optimal configurations of context, mechanism and outcomes in the use of personal health records for medicines optimisation. The study will employ mixed methods: qualitative exploration of user experience (both patient and practitioner) through observation, interviews and prototyping; quantitative analysis of outcome variables such as patient compliance with prescription, metrics of usability and user satisfaction and prescribing/administration errors.